SIGNS & SYMPTOMS TREATMENT: PHARMACOLOGY

PAIN–Jaw, back, mid back/shoulder pain, heartburn (epigastric), Substernal MYOCARDIAL INFARCTION DURING–Any Chest Pain
Key words = priority: “Sudden” “Crushing” “radiating” NCLEX TIP O–Oxygen
SOB “dyspnea” “labored breathing” A–Asa
NAUSEA Vomiting “Abdominal pain” PATHO DIAGNOSTICS N–Nitro–under tongue x 3 Max
SWEATING “Diaphoresis” M–Morphine - Any pain after = MI (injury)
MI=Heart muscles DIE “necrosis” (minutes = muscle death) 1st–EKG AFTER–MI
PALE COOL SKIN “dusky”
Blockage of Coronary Artery “O2 Tube” (Any chest pain or MI symptoms) Clot Stabilization:
ANXIETY
Heparin: prevents CLOT growth (NOT dissolve only t-PA)
PTT: 46 - 70 “3 x MAX” Antidote: Protamine Sulfate
CAUSES Memory Trick: “HaPTT” frog
Heart Rest:
SODDA B–Beta Blockers (-lol) Atenolol
S–Stress, Smoking, Stimulants (caffeine, amphetamines) Blocks both BP & HR (Lol = Low BP & HR)
O–Obesity–(BMI over 25) CAUTION:
D–Diabetes & HTN (over 140/90) B–Bad for Heart Failure patients (CHF)
D–Diet (high cholesterol) animal fats B–Bradycardia (60 or Less) & BP low (HR LESS than 60)
A–African American males & Age (over 50) B–Breathing Problems “wheezing” (Asthma, COPD)
B–Blood sugar masking “hides s/s” (Diabetics)
*Men more than women C–Calcium Channel Blockers
Calms BP & HR-(AVOID Low Hr & BP)
PROGRESSION (Nifedipine, Diltiazem, Verapamil)
“Ischemic heart disease” -dipine “declined BP & HR”
CAM -zem “zen yoga for heart”
C–CAD “coronary artery disease” -amil “chill heart”
A–ACS “acute coronary syndrome” D–Dilators (vasOdilators = O2 to heart)
Angina - Stable “Safer”- relieved w/rest 2nd–LABS Nitroprusside (only for HTN crisis) & Isosorbide
Angina - Unstable “Unsafe” - Unrelieved T–Troponin (Over 0.5 ng/mL) Nitro “Pillow for heart”
M–MI (heart die) NO viagra “-afil” Sildenafil = DEATH!
T–Trauma (ONLY indicator of MI) Nitro drip: STOP if Systolic BP below 90 or 30 mmHg Drop
Other labs: Crp, Ckmb, SE: HA is Common + SLOW Positions changes “syncope”
Myoglobin, CRP (inflammation) DISCHARGE–GOING HOME
Heart Rest:
1st choice A–Ace (-pril) Lisonopril “chill pril”
TREATMENT: PHARMACOLOGY 2nd choice A–ARBs (-sartan) Losartan “relax man”
Antihypertensive (BP ONLY) *HOLD: Low BP (not HR)
PATIENT EDUCATION AC–Anti Clogging of Arteries Precautions:
A–Antiplatlet HOLD if: Platlets 50K or LESS A–Avoid Pregnancy
DRESS “below 50 gets risky” (not INR, not aPTT) A–Angioedema “thick tongue”
D–Diet low (sodium & fluids (2g/2L per day) A–ASA (Airway Risk) *only Ace *NCLEX TIP*
Prevent HF Heart Failure=Heavy Fluid C–Clopidogrel C–Cough *only Ace
Report "New, Rapid" Weight Gain-Water Gain! C–Cholesterol Lowering “-Statin” Creatinine (Kidney) (normal: 0.9 -1.2) *only Ace
R–Reduce Stress, Alcohol, Caffeine, Cholesterol (animal fats) Lovastatin “stay clean” E–Elevated K+ (normal 3.5-5.0) *NCLEX TIP*
E–Exercise (30 min x 5 days/wk) CAUTION: AVOID Salt Substitues + Green Leafy veggies
S–Smoking Cessation NO grapefruit • 1st–Cardiac Monitor
S–Sex (2 flights of stairs with NO SOB) NCLEX TIP Liver Toxic–report “clay colored stools” • High Potassium = High Pump
Muscle pain (Rhabdomyolysis risk) • Monitor: muscle cramps, spasms,
*AVOID NSAIDS (naproxen, ibuprofens) = increases CLOT risk! peaked T waves, ST changes
Late night–take at dinner
 CATH LAB
C–Contrast = Kills Kidneys “Angioplasty, Angiogram, CABG”
A–Allergy to Iodine (warm flushing normal)
B–Bleeding–direct manual pressure (above site)
NO=heparin, warfarin, ASA, clopidogrel
C–Creatinine “Kidney” (normal: 0.9 - 1.2)
REPORT: Creatinine Over 1.3 & Urine below 30 ml/hr
STOP Metformin 48 hrs (before/after)
C–Can’t feel pulses (Pulses = Perfusion O2)
Diminished pulses (4-12 hrs post-procedure) MAX
PRIOITY:
Non palpable pedal pulse AFTER = CALL HCP (Dr.)
Key words: “cool leg, pulse non palpable,
present only with doppler US.”

COMPLICATIONS AFTER MI
ACUTE: (weeks after)
Cardiogenic Shock (severe hypotension)
V fib/V tach (no pulse) = DEADLY
Defibrillate=Don’t have a pulse
Cardioversion=Count a pulse *synchronize*
CHRONIC: (lifetime)
Heart failure “Heavy Fluid”
Rapid weight gain (Water Gain),
Worsening crackles (fluid in Lungs “pulmonary, edema”)
Sudden edema (JVD, peripheral edema “+1 pitting”)
#1 Priority–IV Diuretics–Furosemide, Bumetanide “dried”
(NOT isosorbide)

NitrOglycerin NO viagra “-afil” Sildenafil = DEATH!

NORMAL ADVERSE EFFECT:
HA=Normal Side Effect
Hypotension=Adverse effect
O2 to Heart (need slow position changes)

PILL (or spray) Nitro Patch (Transdermal nitro patch)

S–Stable Angina U–Unstable Angina
S–Safe Angina U–Unsafe Angina
S–Stops when activity STOPS (Stress Induced) U–Unrelieved with rest /Unpredictable (anytime)
*Take Before strenuous activity 1 x daily NOT PRN
GOAL: 1 patch at a time NOT 2 patches
NO chest pain=Daily activities YES Shower is ok
“comb hair, fix hair, get dressed, make up, making bed etc.” LOCATION: Rotate locations Daily
TAKING MED: “Clean, Dry, shaven area” teach patient to wash hands
CALL 911: PAIN 5 min. After 1st dose. after application
3 doses max x 5 min apart Upper Body (subclavian, arm, upper chest)
NO SWALLOW–SL under NOT: hairy, scarred, burned, callous
STORAGE: NOT BROKEN SKIN
NO LIGHT–NO HEAT *TEST TIP: Patch fall off? (Over 1 hour ago)
NOT: pill box, car, plastic bag, pocket Take nitro (pill/spray) New patch can take 40–60 min.
YES: purse ok *Nurses wear gloves! Will cause MAJOR HA if it comes
*Replace every 6 months into contact with skin!

ANTICOAGULANTS (clot prevention) BLEED RISK(Patient Education)

Antiplatelets (LESS potent) NO peptic ulcers (or active bleeds)
ASA & Clopidogrel NO Rugs/dim halls (Well lit halls)
Platelets LESS than 50k = RISKY (Normal: 150–400k) NO razors, hard brushing, constipation
NOT INR or PTT NO NSAIDS like naproxen/ ibuprofen
Anticoagulants (MOST potent) NO EGGO vitamins
Warfarin = INR “warINR” E–E Echinacea, A vitamin
Range: 2.5–3.5 (3 x MAX range) G–Gingko, Garlic, Ginseng
Antidote: Vitamin K (green leafy veggies) *NOT K+ = potassium* O–Omega 3
Heparin (Enoxaparin) = aPTT “HaPTT” frog Partial Thromboplastin Time
Range: 46–70 (3 x MAX range)
Antidote: Protamine Sulfate
 MYOCARDIAL INFARCTION
TREATMENT
(+) Positive Troponin = Heart Attack (MI)
PRIORITY: REMOVE THE CLOT!
“CATH LAB” OR SURGERY CLOT BUSTER “Thrombolytics, Fibrinolytics”
“PCI” -graphy, -plasty t-PA: Alteplase, Streptokinase (Allergy risk)
Dissolves Clot ONLY (heparin does NOT)
BLEED RISK
8 hour duration
NO injections (IV, SQ, IM, ABG)
NOT via central lines (CVC)
ONLY “compressible site” (IV, PICC)
NOT FOR:
Active Bleeds:
Peptic Ulcers (but menstruation is safe)
History:
Arteriovenous malformations
Intracranial “Cerebral” hemmorhage
Hypoglycemia (relative contraindication)
BEFORE AFTER
Hypertension (over 180/110) TEST TIP
NPO 6 - 12 hrs NO heavy lifting–lie flat

NO Baths–Shower ok (dont soak)
Infected Incision
“red, warm, drainage”

STRESS TEST
Non MI (Non priority) • Spot the Narrowing
TREADMILL STRESS TEST CHEMICAL: NUCLEAR PHARMACOLOGICAL STRESS TEST
STOP test: 24–48 hours BEFORE
chest pain NO Cigarettes, Caffeine (tea, soda, coffee) *NO DECAF
ST elevation NO Meds: Nitro, Beta Blocker, Theophylline (stimulant)
NPO (nothing oral) 4 hrs before/after

NOTES